ArticleHealth services research2018
Payer Type and Low-Value Care: Comparing Choosing Wisely Services across Commercial and Medicare Populations.
Article in Health services research, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 36 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
36 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Patient, provider, and system-level factors associated with preoperative cardiac testing: A systematic review.Journal of hospital medicine · 2023Pooled it
- Overuse of diagnostic testing in healthcare: a systematic review.BMJ quality & safety · 2022Pooled it
- Defining and measuring imaging appropriateness in low back pain studies: a scoping review.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2020Pooled it
- Overuse in surgery by deviation from the "Choosing Wisely" campaign recommendations: a surrogate of unnecessary surgery and low-value care.Patient safety in surgery · 2026Article
- Low-value medical orders: bridging the gap between concept and action in reducing healthcare waste.Frontiers in public health · 2026Article
- Is low-value care for persistent musculoskeletal pain more common in rural than urban areas? A scoping review.BMC health services research · 2025Article
- Associations of care continuity and care coordination with the overuse of healthcare services: a nationwide population-based study.BMC health services research · 2024Article
- Relationship Between Insurance Status and Receipt of Cardiac Tests and Procedures During Hospitalization: A Cross-Sectional Study.Journal of the American Heart Association · 2024Article
- Comparison of Low-Value Care Among Commercial and Medicaid Enrollees.Journal of general internal medicine · 2023Article
- Effects of Medicare eligibility and enrollment at age 65 years on the use of high-value and low-value care.Health services research · 2023Article
- Assessing patient, physician, and practice characteristics predicting the use of low-value services.Health services research · 2022Article
- Characterizing the Relationship Between Payer Mix and Diagnostic Intensity at the Hospital Level.Journal of general internal medicine · 2022Article
- Low-Value Prostate-Specific Antigen Test for Prostate Cancer Screening and Subsequent Health Care Utilization and Spending.JAMA network open · 2022Article
- Towards De-Implementation of low-value thyroid care in older adults.Current opinion in endocrinology, diabetes, and obesity · 2022Review
- Identifying drivers of health care value: a scoping review of the literature.BMC health services research · 2022Article
- Vitamin D: a 14-year retrospective study at a clinical laboratory in Brazil.Archives of endocrinology and metabolism · 2022Article
- Exploring emergency physicians' knowledge, attitudes, and behaviour towards Choosing Wisely in Taiwan.PloS one · 2022Article
- Low-value care and excess out-of-pocket expenditure among older adults with incident cancer - A machine learning approach.Journal of cancer policy · 2021Article
- Rates of Low-Value Service in Australian Public Hospitals and the Association With Patient Insurance Status.JAMA network open · 2021Article
- DeepDRG: Performance of Artificial Intelligence Model for Real-Time Prediction of Diagnosis-Related Groups.Healthcare (Basel, Switzerland) · 2021Article
Corrections and comments
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Authors and funding
6 authors.
Funding
Abstract
objectiveTo compare low-value health service use among commercially insured and Medicare populations and explore the influence of payer type on the provision of low-value care. DATA SOURCES: 2009-2011 national Medicare and commercial insurance administrative data.
designWe created claims-based algorithms to measure seven Choosing Wisely-identified low-value services and examined the correlation between commercial and Medicare overuse overall and at the regional level. Regression models explored associations between overuse and regional characteristics.
methodsWe created measures of early imaging for back pain, vitamin D screening, cervical cancer screening over age 65, prescription opioid use for migraines, cardiac testing in asymptomatic patients, short-interval repeat bone densitometry (DXA), preoperative cardiac testing for low-risk surgery, and a composite of these. PRINCIPAL
findingsPrevalence of four services was similar across the insurance-defined groups. Regional correlation between Medicare and commercial overuse was high (correlation coefficient = 0.540-0.905) for all measures. In both groups, similar region-level factors were associated with low-value care provision, especially total Medicare spending and ratio of specialists to primary care physicians.
conclusionsLow-value care appears driven by factors unrelated to payer type or anticipated reimbursement. These findings suggest the influence of local practice patterns on care without meaningful discrimination by payer type.
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Registered trials
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